CYTOXAN

Cytoxan is a brand name for a generic anti-cancer chemotherapy medication called cyclophosphamide. It is a synthetic anti-neoplastic prescription drug that got initial FDA approval in 1959 for the treatment of several types of malignancies. It is also currently in use to treat certain nephrotic syndrome cases in pediatric patients.

Cytoxan tablets contain Cyclophosphamide Monohydrate as its active ingredient and the following inactive ingredients: FD& C Blue No. 1, acacia, stearic acid, lactose, D& C Yellow No. 10 Aluminum Lake, magnesium stearate, talc, and starch. Cyclophosphamide is chemically related to nitrogen mustards and designated as 2- [bis (2-chloroethyl) amino] tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide monohydrate. It is a white crystalline powder soluble in water, ethanol, or saline.

The main function of cyclophosphamide monohydrate is to inhibit the growth of cancer cells by causing DNA damage. It does this by forming covalent bonds with the DNA molecule, which leads to the cross-linking of DNA strands and subsequent disruption of DNA replication and cell division. This ultimately results in the death of cancer cells or slows down their growth.

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Cytotoxin belongs to the pharmacological class: Alkylating antineoplastic agents and Immunomodulators (DMARDs)

• Alkylating antineoplastic agents are compounds that add an alkyl group to the guanine base of a DNA molecule and prevent the linking of strands of the DNA helix. This leads to the breakage of the DNA strands and eventually causes cancer cells to die by preventing their multiplication. Cytoxan comes under the Nitrogen mustard category of alkylating agents. It works to stop or delay the growth of cancer cells within the body.
• Immunomodulators are disease-modifying anti-rheumatic drugs that can help halt or slow down the course of illnesses in different types of cancers, autoimmune diseases, or other inflammatory conditions. These include synthetic compounds toxic to cancer cells, small molecule drugs that can penetrate cells and alter their functions, and biological monoclonal antibodies that act against specific antigens. Cytoxan works as an immunosuppressant and helps treat nephrotic syndrome by impairing the immune system.

Cytoxan is available as white tablets with blue flecks of the following strengths. The blue flecks serve as a visual characteristic to distinguish between the different strengths of the medication.

• 25 mg
• 50 mg

These different strengths allow healthcare professionals to prescribe the appropriate dosage of Cytoxan based on the specific needs and conditions of the patient. The choice of strength depends on various factors, including the severity of the condition being treated, the patient's body weight, and their individual response to the medication.

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Cytoxan treatment is often effective for the following medical conditions:

Malignant diseases/ Cancers: These include:

• Multiple myeloma
• Malignant lymphomas, lymphocytic lymphoma, Hodgkin’s disease, histiocytic lymphoma, mixed-cell type lymphoma, and Burkitt’s lymphoma.
• Retinoblastoma
• Breast carcinoma
• Neuroblastoma
• Adenocarcinoma of the ovary.
• Mycosis fungoides- an advanced type of blood cancer called cutaneous T-cell lymphoma.
• Leukaemia such as acute myelogenous and monocytic leukemia, chronic granulocytic/lymphocytic leukemia, and acute lymphoblastic leukemia in children

Biopsy-proven “Minimal change” Nephrotic Syndrome in Children: Cytoxan can help treat the non-malignant, nephrotic syndrome (kidney disease) in children who can’t get better with adrenocorticosteroid therapy or tolerate it. Nephrotic syndrome is a multifactorial condition characterized by hypoalbuminemia and massive proteinuria.

• The suggested initial or maintenance oral dosing for the treatment of malignant diseases in both adults and pediatric patients is 1mg to 5mg per kg of body weight daily.
• The suggested oral dose for minimal change in nephrotic syndrome in children is 2 mg per kg of body weight daily for 8-12 weeks. If the duration of this dose goes beyond 90 days, there is an increased risk of male sterility.

Cytoxan tablets are available for oral use. These should not be crushed or cut, but instead swallowed as whole after a meal or with food. This is because the tablets are designed in a specific way to ensure the controlled release of the medication in the body.

It is recommended to take Cytoxan tablets after a meal or with food. This is because taking the medication with food can help minimize potential stomach upset or gastrointestinal side effects that may occur. Additionally, food can also help with the absorption of the medication in the body.

The intake of Cytoxan tablets can lead to minor or adverse side effects. The common side effects may include:

• Poor Appetite, Stomach upset, Diarrhea, Stomach Ache
• Nausea, Vomiting
• Temporary Hair Loss
• Tongue or Mouth Sores
• Fever
• Impaired Wound Healing
• Weight Loss
• Missed Menstrual Periods
• Temporary Decrease in the count of Blood Cells- WBCs, RBCs, and Platelets.
• Skin color changes or darkening.
• Nails discoloration

The less common side effects of taking Cytoxan are:

• Sterility in males
• Mouth or tongue sores
• Hemorrhagic cystitis- Bladder irritation or bleeding.

The unlikely, serious side effects of Cytoxan, include:

• Joint pain.
• Easy bruising or bleeding.
• Toxicity of the urinary tract, lungs, heart, embryo/fetus, kidneys, or reproductive system.
• Unusual weakness or tiredness.
• An abnormal decline in urine production or pink/bloody urine.

Cytoxan may interact with other medicines, supplements, or substances. Some drugs known to interact with Cytoxan include:

• Other chemotherapy medicines.
• Allopurinol
• Phenobarbital
• Warfarin
• Digoxin
• Thiazide diuretics (water pills).
• Live vaccines
• Protease inhibitors
• ACE inhibitors
• Depolarizing muscle relaxants such as succinylcholine.
• Cyclosporine
• Metronidazole
• Coumarin
• Natalizumab
• Zidovudine
• Paclitaxel
• Anthracyclines
• Pentostatin
• Cytarabine
• Indomethacin

Cytoxan is not safe for use by:

• People who have earlier demonstrated hypersensitivity to any of the components of the formulation of Cytoxan or any metabolite of cyclophosphamide.
• People having severely depressed functioning of their bone marrow.
• Pregnant women
• Lactating mothers
• Adults having nephrotic syndrome or anyone with other renal diseases.
• Anyone experiencing urinary outflow obstruction.
• Individuals suffering from medical issues like chickenpox, gout, infection, liver disease, shingles, kidney stones, tumor cell accumulation, or have undergone prior removal of their adrenal gland.

• Before starting taking Cytoxan tablets inform about any medications you are already taking. Take only those medicines, supplements, or herbal remedies that the doctor specifically permits.
• Avoid receiving any type of vaccine without taking the doctor’s approval, while on a prescribed course of Cytoxan tablets.
• Use contraceptives to avoid pregnancy during Cytoxan treatment.
• Avoid breastfeeding a child as the drug may pass through breast milk to the child.
• Avoid taking Cytoxan tablets with grapefruit or grapefruit juice.
• Discuss with the doctor about the use of Cytoxan with the food you eat or alcohol.
• During Cytoxan treatment, go for regular laboratory tests to monitor your hematologic profile.
• Be attentive to the possible development of toxicity if taking Cytoxan and having thrombocytopenia, leukopenia, previous X-ray therapy, impaired hepatic/renal function, previous treatments with cytotoxic agents, and tumor cell infiltration of bone marrow.

• Store Cytoxan tablets at controlled room temperature, preferably at or below 25℃.
• This medication can withstand temperatures up to 30℃ for a brief period.
• Avoid keeping the tablets in a humid and well-lit place, at a temperature above 30℃.

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